This issue at a glance
Authors: L SCHENA, J KERRISON
Journal: Ophthalmology (2004)

Sutter et al (p. 2044) found that intravitreal triamcinolone results in a highly significant short-term improvement of visual acuity (VA) in eyes with impaired vision resulting from persistent diabetic macular edema. The researchers studied 43 patients, with 34 eyes randomized to treatment and 35 to a placebo; 65 of the 69 eyes completed the 3-month study visit. Treatment eyes received 0.1 ml of triamcinolone acetonide injected through the pars plana. Fifty-five percent of treated eyes gained ≥5 letters of best-corrected VA, compared with 16% of eyes treated with the placebo. Macular edema was reduced by ≥1 grades in 75% of treated eyes, versus 16% of untreated eyes. Adverse events included infectious endophthalmitis in 1 treated eye. The authors conclude that short-term intravitreal triamcinolone seems effective and relatively safe for macular edema in patients who have failed laser treatment. Although longer-term safety and efficacy studies are necessary, the authors suggest that ophthalmologists consider intravitreal triamcinolone in one eye of patients with intractable diabetic macular edema. Dengue fever is a viral infection transmitted through the bite of an infected female Aedes aegypti/albopictus mosquito. Lim et al (p. 2057) focus on the ocular manifestations of the disease in a retrospective case series of 5 females and 1 male with a sudden decrease in vision 6 to 7 days after initial manifestations of dengue fever. Presenting best-corrected visual acuity ranged from 20/30 to counting fingers. Ocular involvement was bilateral but asymmetric in 5 cases and unilateral in 1 case. Fundus findings included small intraretinal, whitish lesions with localized retinal and retinal pigment epithelium disturbance, small dot hemorrhages, and vascular sheathing around the macula and the papillomacular bundle. The authors found diffuse hyperfluorescence of indocyanine green at the outer choroidal layer with or without silhouetting of the choroidal vessels. They recommend that ophthalmologists be aware of ocular manifestations of dengue infection, given the recent increase in incidence and geographic distribution of the disease. Findings from a study by The Pediatric Eye Disease Investigator Group (p. 2076) indicate that weekend atropine seems to be as effective as daily atropine in treating children ages 3 to <7 who have moderate amblyopia in the range of 20/40 to 20/80. This prospective 30-site clinical trial included 168 children under age 7 with moderate amblyopia who were randomized either to daily atropine or to weekend atropine for 4 months. Those who partially responded continued their specific treatment regimen until no further improvement was noted. Results showed that, at 4 months, improvement of baseline visual acuity averaged 2.3 lines in each group. Additionally, there was no difference between partial responder groups in the improvement achieved beyond the 4-month outcome. Because the magnitude of improvement was similar to that previously reported for 2 or 6 hour per day patching, weekend atropine treatment may serve as another treatment alternative to consider for children with moderate amblyopia. Cognizant of the sustained antiinflammatory effects associated with the use of triamcinolone in the ophthalmic setting, Paganelli et al (p. 2102) embarked on a study to determine its therapeutic use for controlling post–cataract surgery inflammation as an alternative to postoperative steroid drops. In a randomized study of 100 patients undergoing phacoemulsification and intraocular posterior lens implantation, the investigators found that a single intraoperative sub–Tenon's capsule 40-mg triamcinolone acetonide injection had a clinically equivalent therapeutic response to conventional 1% prednisolone eyedrops in controlling postoperative ocular inflammation. Additionally, on the third, seventh, 14th, and 28th postoperative days, a significantly lower intraocular pressure (IOP) was noted in the triamcinolone group than in the prednisolone group. Triamcinolone was also found to be as safe as prednisolone in terms of adverse effects, changes in visual acuity, IOP, and biomicroscopic and ophthalmoscopic variables. The authors conclude that an intraoperative 40-mg triamcinolone acetonide sub–Tenon's capsule injection, with its technical simplicity, lack of complications, and low cost, merits additional investigation. One challenge in managing glaucoma is the need to repeat visual field (VF) testing due to long-term fluctuations of automated perimetry results. What is the minimum worsening of a VF and the minimum number of 6-month visits required to establish true glaucomatous deterioration? The Advanced Glaucoma Intervention Study (AGIS) investigators (p. 2109) attempted to answer these questions with long-term follow-up data based on 12 746 VF test results from 752 eyes of 565 participants who had at least 2 consecutive 6-month VF tests after enrollment. Of these eyes, 737 had at least 3 consecutive 6-month VF tests after enrollment. Visual field tests were quantified with the AGIS VF defect score and the Humphrey Field Analyzer mean deviation (MD) using a follow-up period of 8 to 13 years. For most glaucoma patients, a modest worsening of the VF, 2 units of AGIS VF defect score or 2 decibels of MD confirmed by a single test after 6 months, indicated glaucomatous VF progression.